Léger Alexandre, Ghazali Aiham, Petitpas Franck, Guéchi Youcef, Boureau-Voultoury Amélie, Oriot Denis
Pediatric Department, Basse-Terre Medical Center, Guadeloupe, France.
2Emergency Department, Pitié-Salpétrière University Hospital, Paris, France.
Adv Simul (Lond). 2016 Jun 10;1:21. doi: 10.1186/s41077-016-0021-2. eCollection 2016.
Chest tube insertion is required for most cases of traumatic pneumothorax. However, this procedure entails risks of potentially life-threatening complications. A "surgical" approach is widely recommended to minimize these risks. Simulation-based education has previously been used in surgical chest tube insertion, but not been subjected to rigorous evaluation.
The primary objective was to evaluate the success rate of surgical chest tube insertion in a task trainer (previously published). Secondary objectives were to assess performance with a performance assessment scale (previously designed), to measure the time of insertion, and to seek out a correlation between the learner's status, experience, and performance and success rate. Participants were surveyed for realism of the model and satisfaction; 65 participants (18 residents, 47 senior physicians) were randomized into SIM+ or SIM- groups. Both groups received didactic lessons. The SIM+ group was assigned deliberate practice on the model under supervision. Both groups were assessed on the model 1 month later.
There was no difference between the SIM+ ( = 34) and SIM- ( = 31) groups regarding status ( = 0.44) or previous surgical insertion ( = 0.12). Success rate was 97 % (SIM+) and 58 % (SIM-), = 0.0002. Performance score was 16.29 ± 1.82 (SIM+) and 11.39 ± 3.67 (SIM-), = 3.13 × 10. SIM+ presented shorter dissection time than SIM- ( = 0.047), but procedure time was similar ( = 0.71). Status or experience was not correlated with success rate, performance score, procedure time, or dissection time. SIM+ gained more self-confidence, judged the model more realistic, and were more satisfied than SIM-.
Simulation-based education significantly improved the success rate and performance of surgical chest tube insertion on a traumatic pneumothorax model.
大多数创伤性气胸病例都需要插入胸管。然而，该操作存在潜在危及生命的并发症风险。广泛推荐采用“外科”方法以尽量降低这些风险。基于模拟的教育此前已用于外科胸管插入，但尚未经过严格评估。
主要目标是评估在任务训练器中进行外科胸管插入的成功率（此前已发表）。次要目标是使用性能评估量表（此前已设计）评估表现、测量插入时间，并找出学习者的状态、经验与表现及成功率之间的相关性。对参与者就模型的逼真度和满意度进行了调查；65名参与者（18名住院医师，47名高级医师）被随机分为SIM +组或SIM -组。两组均接受了理论课程。SIM +组被安排在监督下在模型上进行刻意练习。1个月后对两组在模型上进行评估。
SIM +组（= 34）和SIM -组（= 31）在状态（= 0.44）或既往外科插入情况（= 0.12）方面无差异。成功率分别为97%（SIM +组）和58%（SIM -组），= 0.0002。性能得分分别为16.29 ± 1.82（SIM +组）和11.39 ± 3.67（SIM -组），= 3.13 × 10。SIM +组的解剖时间比SIM -组短（= 0.047），但操作时间相似（= 0.71）。状态或经验与成功率、性能得分、操作时间或解剖时间均无相关性。SIM +组比SIM -组更有自信，认为模型更逼真，且更满意。
基于模拟的教育显著提高了在创伤性气胸模型上进行外科胸管插入的成功率和表现。
